Aggression Amongst Outpatients With Schizophrenia and Related Psychoses in a Tertiary Mental Health Institution

Aims: Aggression is defined as “any behavior intended to cause physical, emotional, or psychological harm to another.” The aims of the current study were to (i) examine underlying factor structure of the Buss-Perry Aggression Questionnaire (BPAQ) and (ii) explore socio-demographic and clinical correlates (symptom severity, substance use and alcohol use) among patients with schizophrenia and related psychoses in a multi-ethnic Asian population.Methods: Data collected from 397 participants who were seeking outpatient treatment for schizophrenia and related psychoses at a tertiary psychiatric hospital were included in the analyses. BPAQ, a 29-item, four-factor instrument that measures physical aggression, verbal aggression, anger and hostility was used to assess aggression. Data on socio-demographic variables, age of onset of illness, drug use, alcohol use and symptom severity were also collected. Confirmatory factor analysis (CFA) was performed to establish the underlying factor structure of the BPAQ. Multiple regression analyses were utilized to examine socio-demographic and clinical correlates of the BPAQ factors.Results: The mean age of the participants was 36.2 years (SD = 10.9, range: 21–65). Factor structure obtained from the CFA indicated that a higher order four-factor solution had an acceptable fit to the observed data (WLSMV χ2 = 1,025.35, df = 320, RMSEA = 0.07, CFI = 0.94, TLI = 0.93, SRMR = 0.05). Females had lower physical aggression and hostility scores as compared to males. Those with lower education had higher physical aggression scores as compared to those with higher education. Participants who received a diagnosis after the age of 30 years had higher physical aggression and anger scores as compared to those who received a diagnosis at or before 20 years of age. Symptom severity was positively associated with higher BPAQ scores.Conclusion: The study findings demonstrated high internal consistency and applicable measurement factor structure of BPAQ in this study sample, making it an appropriate questionnaire for assessing aggressive behavior in this population. We also identified socio-demographic and clinical factors that were associated with aggression in patients with schizophrenia and related psychoses.

Liberal Self-Determination, Discrimination, and the Right to Exclude

This chapter defends one of the building blocks of a complete liberal theory of immigration by defending an account of the state’s prima facie right to exclude that has the resources to explain what is wrong with “discriminatory” exclusion in the area of immigration—that is, exclusion on the basis of morally arbitrary features, such as sex, sexuality, and race. Like other statist accounts, the chapter appeals to a right to self-determination to justify a state’s right to exclude. But unlike these other theories, it does not appeal to the psychological harm of insult. The focus is instead on the liberal aspect of self-determination and the surprising ways in which liberal principles constrain the state’s right to both include and exclude prospective new members.

Effectiveness of resilience training on social self-efficacy of the elementary school girls during COVID-19 outbreak

Children, especially girls, are more vulnerable during crises, who need to acquire skills such as social self-efficacy to meet the challenges of the environment. Given that, much progress has been made in e-learning; its capabilities can be used to promote children’s health. This study aimed to determine the effect of virtual resilience training on the social self-efficacy of elementary school girls. This experimental study was performed on primary school girls aged 9–10 years in southeastern Iran. Students were selected by convenience sampling and divided into intervention ( n = 40) and control ( n = 37) groups by using randomized allocation. The Children’s Social Self-Efficacy in Peer Interaction Scale was used for data collection before, immediately, and one month after the intervention. No significant difference was found between the two groups of intervention and control in the score of social self-efficacy before the intervention. However, the score of students in the intervention group improved immediately and one month after the intervention, and a significant difference was observed between the two groups ( p = .0001). Virtual resilience training has improved the social self-efficacy of elementary school girls and facing challenges is inevitable in today’s world, so resilience training seems necessary to prevent social and psychological harm in such children.

Parental Alienation: In the child’s worst interest

Parental alienation (PA) is a form of childhood emotional abuse in which one parent instrumentally uses the child to inflict psychological harm on the other parent for revenge. The consequences of parental alienating behaviours range from mild (e.g., the child shows a certain resistance towards visiting the targeted parent but warm parenting is still possible) to severe, where the positive affective parent–child bond is severed and extremely difficult to reinstate under family therapy. In PA processes, parenting is disrupted with the targeted parent and dysfunctional with the alienating parent. Consequently, the child is at a high risk of developing internalising (e.g., depression, anxiety) and externalising (e.g., use of drugs/alcohol, violence) problems during later developmental stages and through the lifespan. Although the prevalence and severity of PA cases in our societies are largely unknown, in part because the construct is still an ongoing debate among academics, practitioners and family justice professionals, different authors defend that it should be treated as a public health problem. Early prevention should be the primary objective and family justice, child protection and mental health services must coordinate efforts to support the families and promote the best conditions for the development of affected children.

Rainwater's Well-come: Resettling former refugees into New Zealand

<p>There are now an unprecedented number of refugees world-wide. The global impact of this is felt in New Zealand, with the refugee quota set to increase in 2018. The refugee crisis is an important design problem that architects must engage with as refugees are a particularly vulnerable group of people. Typically refugees have been assimilated into New Zealand society, however it is known that this process can cause psychological harm. This thesis seeks to investigate how architecture can thoughtfully and compassionately engage with refugee communities through a design-led investigation which will explore how a dwelling can meet specific cultural and spatial needs while providing opportunities for self-employment, and how a space which is specifically designed for refugee needs can embrace diversity and create opportunities for intercultural dialogue in the wider community. To investigate this, a sociological framework is used as a lens to examine methods of integration which provide potential ways for architecture to be manifested. Refugees often arrive with few economic resources and can be more reliant on the state and their surrounding communities. The biggest issue felt over long-term resettlement for refugees is a lack of employment which has a direct impact as they don’t have enough money to meet their everyday needs. This can also contribute to a negative public opinion about refugees. To address this issue, this thesis seeks to investigate how a hybrid building type, the shop-house, could be explored to provide refugees a dwelling that could meet their specific cultural and spatial needs and create potential opportunities for self-employment, self-determination and intercultural contact. The shop-house is a fundamental feature of a city, and can provide an economic foothold for people of all economic means. However, this thesis discovers its limitations and explores an alternative option to allow a refugee community to put down roots and make a new life in a new country which also enriches the host community.</p>

Rainwater's Well-come: Resettling former refugees into New Zealand

<p>There are now an unprecedented number of refugees world-wide. The global impact of this is felt in New Zealand, with the refugee quota set to increase in 2018. The refugee crisis is an important design problem that architects must engage with as refugees are a particularly vulnerable group of people. Typically refugees have been assimilated into New Zealand society, however it is known that this process can cause psychological harm. This thesis seeks to investigate how architecture can thoughtfully and compassionately engage with refugee communities through a design-led investigation which will explore how a dwelling can meet specific cultural and spatial needs while providing opportunities for self-employment, and how a space which is specifically designed for refugee needs can embrace diversity and create opportunities for intercultural dialogue in the wider community. To investigate this, a sociological framework is used as a lens to examine methods of integration which provide potential ways for architecture to be manifested. Refugees often arrive with few economic resources and can be more reliant on the state and their surrounding communities. The biggest issue felt over long-term resettlement for refugees is a lack of employment which has a direct impact as they don’t have enough money to meet their everyday needs. This can also contribute to a negative public opinion about refugees. To address this issue, this thesis seeks to investigate how a hybrid building type, the shop-house, could be explored to provide refugees a dwelling that could meet their specific cultural and spatial needs and create potential opportunities for self-employment, self-determination and intercultural contact. The shop-house is a fundamental feature of a city, and can provide an economic foothold for people of all economic means. However, this thesis discovers its limitations and explores an alternative option to allow a refugee community to put down roots and make a new life in a new country which also enriches the host community.</p>

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of “frustrating moral expectations” emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.

Application Effect of Computer-Assisted Local Anesthesia in Patient Operation

In order to avoid the psychological harm caused by pain to patients, in this study, the application effect of computer-assisted local anesthesia in patient surgery was studied. In this method, 72 patients with hypertension, 35 males and 37 females, aged 53–83 years, with an average age of 70.8 ± 1.3 years, were selected for appointment tooth extraction in the department of stomatology from January to December 2014. All patients were booked for tooth extraction by ECG monitoring. Patients who were contraindicated for tooth extraction, had a history of mental illness, and had used antianxiety drugs and sedatives within 1 week before surgery were excluded. Patients were randomly divided into two groups according to their ID numbers: observation group, 36 cases, and control group. Painless oral local anesthesia injection instrument was used for local anesthesia injection. In the control group, 36 patients were injected with local anesthesia by traditional manual injection. The results showed that 86.11% of patients in the observation group had decreased anxiety scores after anesthesia, while only 13.88% of patients in the control group had decreased anxiety scores. Among patients with decreased anxiety scores, 80.65% in the observation group became nondental anxiety compared with 28.57% in the control group. Computer-assisted oral local anesthesia can effectively control dental anxiety and relieve the pain and discomfort of local anesthesia injection, and improve patient satisfaction, conducive to the smooth nursing work.

Return of individual research results from genomic research: A systematic review of stakeholder perspectives

Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.

Management approach of patients with violent and aggressive behaviour in a district hospital setting in South Africa

Aggressive and violent behaviour is very common in the hospital setting. Simple agitation may unpredictably progress to overt aggression and violence by any patient in the emergency centres (ECs). Aggressive behaviour often manifests in forms of verbally abusive language, verbal threats and intimidating physical behaviour. Violent behaviour comprises the intentional use of physical force or power, threatened or actual, against self (suicidal), or another (homicidal) or properties, group or community, that could potentially result in injuries, death, psychological harm or deprivation. Therefore, individuals with unusual agitation and aggression should be treated as an emergency in both the community and healthcare settings in order to mitigate the progression to physical violence. Whilst the incidence and prevalence of aggressive and violent behaviour are higher in individuals with an underlying mental disorder, substance use disorder or comorbid mental disorder and substance use disorder, other individuals can also present with these behaviours in the ECs. Therefore, the front-line clinicians must be knowledgeable and competent in managing patients with aggressive behaviour with a view to de-escalate the situation and preventing or curtailing violence. This paper presents an evidence-based approach for managing patients with aggressive and violent behaviour, including a review of the steps for admitting patients for assisted or involuntary care.